Is There Anything Good About HIPAA?

It seems the only thing most health care professionals have been talking about lately is HIPAA, HIPAA and more HIPAA! The talk centers on how HIPAA will be impossible to implement, cost you a fortune and basically convert your office into Fort Knox. You can't use sign-in sheets anymore, you have to lock up all of your files, and you have to hide everything in your office from everyone. Oh, and don't forget that you can be fined up to $250,000 and spend 10 years in jail (per incident) if you violate any of the privacy regulations.

With all this negative stuff floating around, I thought I'd take a moment and share some of the "benefits" that will be available to your practice because of HIPAA. From my perspective as a management consultant specializing in practitioner insurance and payment concerns, I see HIPAA as just another procedure.

After the initial process of becoming compliant with your policies and procedures, you will probably forget all about the scare of HIPAA. In about a year, it will just be another set of procedures that will fold into your daily routine. In effect, all you're doing is swapping one set of forms and procedures for another. If you're using the correct HIPAA compliance software, you've already discovered that it was harder in 1992, when you had to convert from "Office Visits" to "Evaluation and Management" codes, than it is to convert to HIPAA's daily routine!

One of the provisions of HIPAA is the set of new Transactions Standards. I personally think this area alone is going to be one of the most beneficial things to happen to your practice, ever! Many of you probably think this provision refers only to the HCFA claim form. The truth is, this provision contains the following requirements that must be implemented by the entire insurance industry by Oct. 16, 2003:

Specifically Electronic Data Interchange standards have been adopted for:

1. health claims/encounter information;
2. enrollment/disenrollment in a health plan;
3. health care payment and remittance advice;
4. eligibility for a health plan;
5. health plan premium payments;
6. health claim status;
7. referral certification and authorization;
8. coordination of benefits;
9. standards for claims attachments; and
10. standards for first report of injury.

Recently, I participated in a HIPAA program for a large state chiropractic convention. I asked the staff in the room how long it takes to verify a patient's insurance, and heard a collective groan from the audience! For some, it took as little as 30 minutes, but for others, it took up to a full day. Imagine if it was possible to go to the Internet and verify a person's eligibility in a health plan; coverage for chiropractic services; applicable deductible; deductible balance; and any limitations and obtain authorization if needed! What if you could even print out a confirmation of this information? Sound like a fantasy?

Look back at the aforementioned new requirements of all insurance companies. You will be able to do all of these things (and more) because of HIPAA. In fact, some insurance companies are already working toward complete compliance, and are providing these services now.

Do you want to see compliance in action, right now? Go to the Internet, type in www.cigna.com, click on the "provider" tab and eat your heart out! You could have been doing this already for the last six months, if you'd known about HIPAA and its positive side.

Many states have a 30- to 45-day insurance pay law. Here in California, we have a 30-day pay law, and the insurance company is required to pay a penalty and interest for paying late. Supposedly, you can get the company in a great deal of trouble by filing a complaint with the insurance commissioner's office for noncompliance.

The only problem with all of this is that when you try to do your follow-up on an outstanding claim, there is usually no one to talk to! It may take anywhere from two hours to two days to hear from an insurance company about the status of your claim. Even then, the answer is usually: "We didn't get your claim" or "It's in the mail," making the whole process time-consuming and unrewarding. This is all about to change. Starting Oct. 16, you will be able to check the status of your claim online, anytime you feel like it, with every insurance company. At last, the 30-day pay law will be enforceable nationwide.

Personally, I think you are about to get paid faster, more uniformly and with less hassle - and that's not even the best part. Once you're HIPAA-compliant, you'll have more time, energy and money, and less aggravation. You'll even spend less on postage! Along with new procedures, HIPAA delivers significant benefits. You just have to take advantage of them.

Howard Ross
Rancho Santa Margarita, California